title: Adult ABO-incompatible liver transplantation by intraportal transfusion of donor-specific antigen: a case report.
abstract: A 55-year-old-woman suffering from fluminant hepatitis owing to autoimmune hepatitis underwent ABO-incompatible liver transplantation (LRLD) of blood type A to B. In this study, we investigated whether a new immunosuppressive strategy by intraportal transfusion of donor-specific leukocytes (DSLT) separated from whole blood would yield immunological benefit in adult ABO-LRLD. The operative course was uneventful; she was discharged at 46 days postoperatively without humoral or cellular rejection. On immunologic analysis, 54.6% intrahepatic macrochimerism of donor type CD56+ T cells was recognized at 1 month after transplantation. The interleukin-10 Th2 cytokine level was increased on postoperative day 1. Adult ABO-incompatible liver transplantation can be performed with acceptable patient and graft survival rates with a low risk of antibody-mediated rejection with our strategy of immunosuppression by intraportal administration of DSLT. Donor type CD56+ NKT cells may induce tolerance by a veto mechanism and/or an anti-idiotype network. ABO-incompatible liver transplantation may be improved by this strategy.
authors.affiliation: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan. kanishok@med.niigata-u.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: S
authors.initials: S
authors.lastname: Yamamoto
authors.forename: H
authors.initials: H
authors.lastname: Oya
authors.forename: H
authors.initials: H
authors.lastname: Nakatsuka
authors.forename: T
authors.initials: T
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
authors.forename: Y
authors.initials: Y
authors.lastname: Hara
authors.forename: H
authors.initials: H
authors.lastname: Kokai
authors.forename: K
authors.initials: K
authors.lastname: Hatakeyama
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D015703:Antigens, CD / Q000276:immunology; D001787:Blood Group Incompatibility; D019002:CD56 Antigen / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D019693:Hepatitis, Autoimmune / Q000601:surgery; D006801:Humans; D007694:Killer Cells, Natural / Q000637:transplantation; D017708:Leukocyte Transfusion; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000276:immunology; D014019:Tissue Donors; D018183:Transplantation Chimera
chemical_list: D000017:ABO Blood-Group System; D015703:Antigens, CD; D019002:CD56 Antigen